Provider Demographics
NPI:1063938397
Name:COCKRELL, KASANA ROCHELLE (HHA)
Entity type:Individual
Prefix:
First Name:KASANA
Middle Name:ROCHELLE
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4007
Mailing Address - Country:US
Mailing Address - Phone:740-564-5803
Mailing Address - Fax:877-349-1843
Practice Address - Street 1:5716 CAIRO RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4007
Practice Address - Country:US
Practice Address - Phone:740-564-5803
Practice Address - Fax:877-349-1843
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH24512869Medicaid